At The Center for Stress and Anxiety Management, our psychologists have years of experience. Unlike many other providers, our clinicians truly specialize in the diagnosis and treatment of anxiety and related problems. Our mission is to apply only the most effective short-term psychological treatments supported by extensive scientific research. We are located in Rancho Bernardo, Carlsbad, and Mission Valley.

What is your go-to when you feel stressed out? Do you like a few glasses of wine, an hours long vent session, or a creative excuse to get out of a social engagement? These are all examples of experiential avoidance—an unwillingness to experience uncomfortable internal emotions or sensations and active efforts to change, reduce, or eliminate them (Forsyth and Eifert 1996). Does experiential avoidance work to alleviate feelings of stress? Yep. It works or we wouldn’t do it. But how long does that last? Look at your personal experience and take inventory:

1. what do you do or not do when you feel stressed?

2. what does it get you (i.e., what discomfort does it relieve)?

3. what is its cost?

When our reactions to stress result in only temporary relief but come at a cost to our health, our relationships, or other areas of importance, it’s time to reevaluate our relationship to stress.

Think of it this way (Stoddard, 2019): Imagine I have you in a little booth suspended above a barracuda tank. I tell you, “Whatever you do, don’t get stressed and you will be fine. Unfortunately, if you do feel stressed, the floor of the booth will open, dropping you into the barracuda tank. But just don’t get stressed and you will be totally fine!”

What do you think is going to happen? Right—you’re stressed…and fish food. Is it because you just didn’t try hard enough to control your stress? Was the incentive not quite high enough? Of course not—our most primitive instinct is to survive. So why did you get stressed and end up swimming with the fishes? Because when you are unwilling to experience stress, you are stressed about stressso you are stressed (Hayes, Strosahl, and Wilson 1999). See the trap? Your relationship to stress becomes one in which you evaluate it as bad, dangerous, and deadly.

So, of course, you are stressed about having stress.

So what should you do the next time you hear on Good Morning America or in the Huffington Post “Stress is bad for you! Stress will kill you! You shouldn’t get stressed!” It turns out, stress has been wrongfully getting a bad rap (McGonigal 2013). While stress does release adrenaline (the hormone thought to be harmful to the body), it also releases oxytocin, the bonding hormone that enhances empathy and motivates us to seek and give care. Oxytocin is a natural anti-inflammatory—it’s good for our bodies and actually strengthens our hearts. And, fascinatingly, all we have to do to mitigate the negative effects of adrenaline is simply appraise stress as helpful.

Come again? Stress, helpful? YES--stress can motivating! Stress is what prompts you to prepare for the important job interview, watch over your small children in a crowded place, and get ready for the big game. If you were totally chill, you’d likely bomb the interview, lose your kid at the mall, and blow the game. As it turns out, there is an optimal arousal zone when it comes to doing well (Yerkes and Dodson 1908): when stress is very high or very low, it has the potential to negatively impact performance. But a moderate level of arousal is helpful.

The best way to manage stress is simply to change your relationship to it. So stop struggling to avoid and reduce your stress (how’s that working for you, anyway?), and instead work on accepting that to be human is to know stress, and stress need not be our enemy. You can do that by remembering:

1. stress is motivating and can improve performance at moderate levels

2. stress prompts us to seek connection with others and this is good for our health

3. stress is only damaging when we evaluate it as damaging

4. when we are stressed about stress we are stressed

Now, don’t get me wrong—I’m not suggesting you give up your meditation practice because it makes you feel less stressed. There is nothing wrong with getting your bliss on—as long as your strategies don’t come at the cost of other meaningful and important pursuits. So go ahead and yoga-it-up—just don’t neglect your friends and family while you’re at it.

CSAM IS HERE TO HELP

If you or someone you love might benefit from cognitive behavioral therapy (CBT) or acceptance and commitment therapy (ACT) for anxiety, depression, stress, PTSD, insomnia, or chronic illness, or if you would like more information about our therapy services, please contact us at (858) 354-4077 or at info@csamsandiego.com

References

Forsyth, J. P., and G. H. Eifert. 1996. “The Language of Feeling and the Feeling of Anxiety: Contributions of the Behaviorisms Toward Understanding the Function-Altering Effects of Language.” The Psychological Record 46: 607–649.

"All men dream: but not equally. Those who dream by night in the dusty recesses of their minds wake up in the day to find it was vanity, but the dreamers of the day are dangerous men, for they may act their dreams with open eyes, to make it possible.”

I’m a dreamer. Always have been. Ever since I could remember, I wanted to do remarkable things that would make the world a better place. Over the years, I’ve had lots of ideas for how to do this but often I would ‘wake up in the day to find it was vanity’. In other words, the ideas remained just that; ideas. On a recent project, I became a ‘dreamer of the day’.

I research an approach to human suffering named Acceptance and Commitment Therapy (ACT). The pitch of ACT goes something like this: if we can be willing to experience all of our thoughts and feelings, both positive and negative, whilst continuing to move in valued directions, then we will do a decent job at this game of life. One night, after delivering an ACT intervention to teachers, I had this thought: “It is really easy to forget our values; I need to create something that will remind people of what is important to them.” In the following weeks I came up with the idea of an annual diary. For the most part, this diary would be like any other diary i.e. it would have days and dates and spaces to record meetings. However, it would also provide an opportunity for the user to record what is important to them at the beginning of each week.

Ok, so there was the idea. Now I had to do something with it. The first step was easy; I loaded Microsoft Word and spent hours and hours and hours (with my co-author Dr. Freddy Jackson Brown) shaping the words and lines that would make up the inside of the diary. The second step was more difficult. I had to figure out how to take that file and turn it into a product. First question: a publisher or a printing house? No publisher was interested so we went with a printing house. Then, more questions. What sort of spine to go for? How thick should the paper be? How many copies should we buy? How should we sell it? What are the best postage and packaging options? How should we advertise it? How should we accept payment for it? How do we pay tax? Who is going to post them? How should we grow the product over time?

During the first and second steps I faced a fair bit of discomfort (i.e. seemingly powerful negative thoughts often crossed my mind: “this is a waste of time”, “nobody will like it” or “you should be spending this time with Max”). However, the third step of making my idea a reality brought the most discomfort: once I had the completed product, I sent it out there into the scary world. And given that success or failure has implications for how I feel about myself, my diary is a bit like a Horcrux in the Harry Potter story. In that story, the bad guy (Voldemort) poured his soul into a number of items and placed them out there in the world. Those items were called ‘Horcruxes’. His thinking was that this strategy would make him more difficult to kill.

Like Voldemort, I poured my soul into this Horcrux. And like Voldemort, any attack on the Horcrux feels like it kills a part of my soul (‘attack’ is an extreme word that is possibly misplaced here. By ‘attack’, what I mean is any evidence I see that the diary is not worthy, whether it be a lack of sales, little interest on social media or negative feedback). My Horcrux diary is now out there in the world fending not just for itself but, in some ways, for me also. A bit of my soul is unprotected; it can be scrutinized, criticized or ignored. It can fail. And if it fails then it will hurt like hell.

The feeling of vulnerability that comes with trying to do something remarkable is tiring, and it often makes me question whether it would have been better to stay a ‘dreamer of the night’. If my Horcrux is inside my mind then nobody can see it; nobody can hurt me. However, every time I think about this I come to the same conclusion. Although being a ‘dreamer of the night’ comes with built-in safety, if I didn’t do something with my dreams then I’d be living a life out of step with my value of making the world a better place, and consequently, I’d feel empty.

Why am I telling you all this? For two reasons. Firstly, I want you to see how ACT is in my blood. Just in this blog you will spot how I used important ACT processes (willingness, defusion, self-as-context, values). Secondly, and more importantly, I want you to see that having ACT in my blood helped me to chase my dreams, and that it can help you to do the same. Chasing dreams will bring vulnerability but if you know what to do with vulnerability then you will be free.

Interested in checking out Dr. Hooper’s Annual Diary for Valued Action? Check it out here.

CSAM IS HERE TO HELP

If you or someone you love might benefit from cognitive behavioral therapy (CBT) or acceptance and commitment therapy (ACT) for anxiety, stress, PTSD, insomnia, or chronic illness, or if you would like more information about our therapy services, please contact us at (858) 354-4077 or at info@csamsandiego.com

Choosing a therapist can be overwhelming. If you search Google or Psychology Today, you will likely find a long list of different therapists including licensed marriage and family therapists, licensed professional clinical counselors, licensed clinical social workers, psychologists, and psychiatrists. How do you know what kind of therapist will be the best for you? And what is the difference between all those different licenses?

Licensed Marriage and Family Therapists (LMFT):

An LMFT holds a Master’s degree in counseling, which typically involves between two and three years of school. LMFTs are trained to view individuals from a family systems perspective, meaning that they learn to see individuals in the context of their relationships. Relationships include family, friends, significant others, and even your relationship to yourself. Despite what their license seems to imply, LMFTs also work with individual clients; they do not exclusively offer marriage and family therapy. Their license speaks to the lens through which they view clients and the various presenting problems they may bring into therapy. LMFT’s must complete at least 3,000 hours of supervised experience before becoming licensed, and this experience must include working with children, families, and/or couples.

An Associate Marriage and Family Therapist has completed their Master’s but is still working on their 3,000 hours of supervised experience.

Licensed Professional Clinical Counselors (LPCC):

An LPCC also holds a Master’s degree in counseling. Many Master’s programs qualify students to sit for both the LMFT and LPCC licensing exams. However, LPCCs tend to work more generally, with a focus on mental health issues as opposed to relational issues, and tend to focus on the individual rather than the individual in the context of their relationships. LPCCs also must complete 3,000 hours of supervised experience prior to licensure, and a portion of their experience must be in either a hospital or community based mental health setting.

An Associate Professional Clinical Counselor has completed the Master’s degree requirements but is still working toward the 3,000 hours of supervised experience.

Licensed Clinical Social Workers (LCSW):

An LCSW holds a Master’s degree in social work. Their training teaches them to help connect clients with resources, both externally (like community resources, support groups, etc.) and internally (like coping skills). An LCSW must complete 3,200 hours of supervised experience in order to get licensed, and they must be supervised specifically by another LCSW for a portion of their hours. They may also provide individual, family, or couples therapy, but the lens through which they have been trained focuses on ensuring clients have access to all the resources they need to thrive.

An Associate Clinical Social Worker has completed the Master’s degree requirements but is still working toward the 3,200 hours of supervised experience.

Psychologists:

A licensed psychologist holds a doctorate degree, either a Ph.D. (doctor of philosophy in psychology, focused on both research and clinical work) or a Psy.D. (doctor of psychology, more clinically focused than research focused), which can take between four and seven years to complete. Licensed psychologists also require 3,000 hours of supervised clinical experience for licensure. Psychologists typically have more training in psychometric assessment and test administration than an LMFT, LPCC, or LCSW. A psychologist with a Ph.D. is prepared to practice clinical work, conduct research, and/or teach, whereas a Psy.D. is typically primarily focused on clinical work.

Registered Psychological Assistant or Postdoctoral Fellow: A registered psych assistant is still working toward the doctoral degree and receiving supervised clinical experience. A postdoc has already completed the doctorate, but is completing the supervised clinical experience hours toward licensure.

Psychiatrists:

A psychiatrist holds a medical degree, and has completed a period of residency, and fellowship. Psychiatrists are medical doctors and are able to prescribe medications. A psychologist, LMFT, LPCC, and LCSW are not able to prescribe medication. Psychiatrists are also able to provide psychotherapy services, but their training is more medically focused.

What’s the takeaway?

Ultimately, there can be a lot of overlap in the services provided by the above practitioners. They are all qualified to assess, diagnose, and treat the full range of mental and emotional disorders found in the Diagnostic and Statistical Manual (DSM). The specific license under which a therapist operates speaks to the lens through which they have been educated, and the duration of education.

However, the provider’s area of expertise and scope of practice tends to depend upon the clinical experience that they have gained. So when looking for a therapist, it can help to understand what their license means, but it is perhaps more important to understand the specific supervised and licensed experience that the therapist has. Do they have experience working with anxiety, panic, trauma/PTSD, depression, identity issues, couple’s therapy, child therapy, family therapy? What modalities are they trained in? Cognitive Behavioral Therapy, Acceptance and Commitment Therapy, Psychodynamic Therapy, EMDR, Emotion Focused Therapy, Somatic Therapy? Do their areas of expertise and treatment modalities align with your needs and goals?

Research consistently shows that the therapeutic relationship is the most important factor in whether therapy is successful. So it’s key that the therapist you choose feels like the right fit for you personally. But it can be hard to try to figure out who might be a good match based on credentials and website information alone. A good place to start in narrowing your search is looking at the therapist’s areas of expertise and preferred treatment modalities. Once you have found someone whose specialties line up with your goals, you can reach out to the provider and ask any questions that may not have been addressed on the practice website. (If they won’t take the time to respond to your questions, they might not be the best fit!) If you feel comfortable with the therapist during the initial contact, you can schedule your first session. You will want to meet with the therapist 2-3 times to evaluate how safe and comfortable you feel working with this person. Choosing a therapist is a process, and it can feel overwhelming at first. But once you know how to narrow your search and find a provider that feels like a good fit, it can be incredibly rewarding.

Anxiety can work its way into many aspects of a person’s life, which is why it’s so important to find the resources, support, and advice you need — whether it comes from people’s stories, helpful phone apps, or expert advice.

We caught up with her to learn about some of the ways she recommends for managing anxiety disorders.

Dr. Jill Stoddard’s advice for anxiety

1. Use your senses

Anxiety narrows your focus onto perceived threats (i.e., whatever you’re feeling afraid of or worried about in the moment) which can impact your focus and memory. Practice mindfully broadening your view by using your senses — what do you see, hear, smell, etc. — to improve attention and experience.

2. Have gratitude

Practice gratitude as another way to broaden your focus. There are the things that you worry about, and there are also the things you’re grateful for.

3. Be accepting

Difficulty with uncertainty and a lack of perceived control amplify anxiety. To “fix” this, we often attempt to get more certainty and more control — for example, by doing internet searches about health symptoms. This actually increases anxiety in the long run.

The antidote is acceptance of uncertainty and control. You can read a book or watch a sporting event without knowing the ending. In fact, it’s the anticipation that makes it exciting! So try bringing this attitude of openness to not knowing, and letting go of control. See what happens.

4. Face your fears

Avoidance is anything you do, or don’t do, to feel less anxious and prevent a feared outcome from occurring. For example, avoiding a social situation, using drugs or alcohol, or procrastination are all examples of avoidance.

When you avoid what you’re afraid of, you get short-term relief. However, this relief never lasts, and before you know it, that anxiety has returned, often with feelings of sadness or shame for having avoided it. And often, the exact avoidance strategies you’re using to feel better and prevent a feared outcome (e.g. reading off your notes during a speech or avoiding eye contact) actually create the outcome you’re trying to avoid (namely, appearing anxious or incompetent).

Consider taking small steps to start facing your fears. What’s one thing you might do that takes you out of your comfort zone? You will build mastery and confidence, and your anxiety might even diminish in the process.

5. Define your values

Do some soul searching about what really matters to you. Who do you want to be? What do you want to stand for? What qualities do you wish to embody as you engage in work or school, or interact with people you care about? If friendship matters, how can you create space in your life for that? When you do so, what qualities do you wish to embody as you spend time with friends? Do you wish to be authentic? Compassionate? Assertive?

These are all values, and making choices in line with values — rather than in the service of avoidance — may or may not impact your anxiety, but will definitely add richness, vitality, and meaning to your life.

Healthline’s tips

To help you keep your anxiety in check, Healthline also recommends trying out the following products in your day to day:

Add some lavender essential oil to your lotions and soaps, use as an air freshener, or rub small diluted amounts onto your neck or feet.

Take Kavinace supplements, which can help with anxiety-related sleep issues.

Two days ago, Thursday June 1st 2017, an article in The New Scientist magazine was published that I co-wrote. It is a great achievement because it will be one of the largest impact writings about Relational Frame Theory (RFT) i.e. it is possible that more people will lay their eyes on this article than for any other RFT article that currently exists.

At a personal level it feels like a big deal; it feels like an ‘I made it’ moment. And, of course, ‘I made it’ moments matter only because of the history of moments where me making it wasn’t, by any means, a sure thing. I think of my A-Levels where I studied like hell for Psychology and scraped a B. I think of the first two years of my degree where my average mark was 57 (see picture below) and I think of starting my self-funded PhD where some members of staff in the Psychology Department weren’t happy about me being accepted onto the program because I wasn’t ‘PhD material’. How the hell did I, an average boy from a working class family, make it to a point in my life where I publish in a magazine that has a readership of over 100,000 people?

The answer is quite simple. When I was 20, I started reading a book about a new approach to human suffering named Acceptance and Commitment Therapy (ACT). This is when everything changed for me. Prior to this point, unhelpful thoughts and feelings heavily influenced my decisions. Sure, they kept me in a comfort zone where I was safe but in that comfort zone I could make no progress towards the things that were important to me.

Have you seen the film ‘Yes Man’ with Jim Carrey? The film documents how a man’s life changed when he started saying ‘yes’ to everything. It’s a cool idea and following what I learned about ACT it is pretty close to the way I began interacting with the world. Of course, I differ from ‘Yes Man’ in that if someone asks me to steal a pig from a farm and paint it green then I wont say ‘yes’ (most of the time). However, if someone asks me to do something that is in line with my values, and provided this something wont infringe too much on my ability to self-care, then I say ‘yes’.

Over the years I have especially said ‘yes’ when the offer made me feel uncomfortable or when my mind fed me thoughts like: ‘You’re going to get found out – you’re not smart enough to do this’. My values guided my decision-making. Yes to a PhD, Yes to presenting my work at international conferences, Yes to travelling to the US to meet people like Steve Hayes and Kelly Wilson, Yes to lecturing in Cyprus, Yes to writing a book, Yes to going to the ACT Dublin Conference, Yesto meeting up in Bristol with some people I met at that conference, Yes to setting up an ACT centre with those people, and Yes to trying to write this New Scientist article with those people. Sure, it wasn’t plain sailing and it brought me plenty of failure and discomfort along the way but there is no doubt that I am where I am because of how readily I said ‘yes’. And I was able to say ‘yes’ because ACT taught me that saying ‘yes’ to things that are important to you, even when they bring discomfort, is a way of living that brings liberty and fulfillment (see any recent work by Aisling Curtin and Trish Leonard to learn more about ACT inspired comfort zones).

I guess you might be wondering why I am telling you these things. Well, for two reasons. Firstly, I wanted to advocate for ‘yes’ living because of the positive effect it has had on me. However, secondly, and more importantly, I wanted to make a prediction for the future. Here I am, one average person, who became introduced to ACT, started moving outside of his comfort zone when his mind told him that he wasn’t worthy or capable, and started to achieve remarkable things (relative to what I thought was possible). But I am not the only person in the ACT community with that story. You see the thing about ACT is that it isn’t an approach you ‘do’ to other people; it is an approach that starts with oneself. So here is my prediction: ACT will get bigger and will stay the course. I don’t think this will happen because ACT will win therapy wars with 1000’s of studies (those wars don’t have winners). I think it will happen because over time more and more ‘average’ people will start to achieve remarkable things by saying ‘yes’ when their mind tells them that they aren’t good enough. If this does happen then although none of us will be remembered as individuals, as a ‘yes’ community we might just change the world.

People are talking about mental illnesses, like anxiety disorders, more often and more openly. Social media and access to digital content has helped facilitate the conversation. However, there is still a stigma surrounding mental illness, and while easy access to content can help reduce shame, stigma and misunderstandings about mental illness, it can also spread mistruths and foster outdated myths. This hurts those who suffer from mental illnesses as well as those trying to understand and support them. So let’s clarify some things about anxiety.

Anxiety is a blanket term. We all know what it feels like to feel anxious. But when we talk about anxiety as a mental illness, we may be referring to any number of disorders, from generalized anxiety disorder to social anxiety disorder to panic disorder to a specific phobia. Though all of these things fall under “anxiety,” each manifestation looks and feels a bit different.

Fortunately, anxiety disorders can be treated. Having a supportive network that includes mental health professionals and ideally, understanding loved ones, is critical. The first step toward encouraging and facilitating treatment is dispelling myths and providing education for both those struggling with anxiety and the people around them. Here are five of the biggest myths about anxiety disorders:

1. “You don’t really have anxiety. Everyone gets anxious/nervous!” Of course, everyone feels anxious or stressed sometimes. But according to the DSM V, when someone has an anxiety disorder, they feel excessively anxious about a number of things more often than not, and it significantly impairs their ability to function in a major area of their life. We must understand that there is a big difference between feeling anxious about a particular event or challenge, and feeling the chronic anxiety that comes with an anxiety disorder. Furthermore, it’s important not to toss around statements such as “I’m so OCD” when all we mean is that we like our desk organized. Minimizing an anxiety disorder in these ways undermines the challenge that something like generalized anxiety disorder or OCD can pose to people who are struggling with them.

2. “You can get over anxiety with yoga, taking a walk, or meditation.” While taking a holistic approach to wellness is smart, and such activities can help with the symptoms of anxiety, taking a yoga class won’t “cure” an anxiety disorder any more than it will spina bifida. Though it can be tempting to offer advice to try to help those struggling with anxiety, it’s important not to minimize their experience or assume that you have a solution to offer them. Only a mental health professional should be offering any kind of “prescription” or suggestion for treatment.

3. “Anxiety means a person is weak, or they must have had a really bad childhood.” The former is never true; the latter could be part of the foundation for an anxiety disorder, though this is certainly not always the case. Trauma can kick start an anxiety disorder, but it’s not the only source. A big reason people with mental illnesses don’t talk about their condition is because they don’t want to be seen as weak or feeble, even though they’re not. It takes tremendous strength to live with any disorder. Invisible disabilities can be especially trying because people can’t “see” the disorder a person is battling.

4. “Anxiety isn’t that big of a deal.” Everything is relative. Anxiety disorders exist on a spectrum. If you know someone with anxiety, you can’t gauge how severe their disorder is. But unless you are a therapist, psychiatrist, or doctor, it’s not your job to gauge the severity of someone else’s anxiety. What you need to know is that anxiety is a big deal to the person suffering from it, no matter where they fall on the spectrum. Further, unlike a broken leg, anxiety can’t be seen on the outside. So someone may appear perfectly put together on the outside, but is suffering in silence on the inside.

5. “I won’t be able to relate to someone with anxiety.” This myth is usually based on a person’s fear that they won’t know what to say when someone is struggling with anxiety. It’s human nature to want to “fix” things, but anxiety can’t be fixed that easily, especially by a non-professional. Remember that it’s not your job to “fix” someone’s anxiety or make it go away. All they really need from you is empathy. And listening well is far more important than knowing what to say. So when talking to someone with anxiety, let them lead the conversation, don’t judge them, and don’t try to fix it. Let them know that you want to understand and that you hear that they are struggling. You might also offer to help them connect with professional help.

We’ve come a long way in our understanding of anxiety disorders. Psychological research has given us a solid understanding of anxiety and how to treat it effectively. Of course, there is always more to learn, but now the bulk of our work lies in sharing our understanding with the community and eliminating the damaging and unnecessary stigma that still surrounds mental illness. Working to un-learn false claims and myths of the past is a big step in the right direction. Doing your part to educate yourself and others will make a big difference in the lives of everyone with an anxiety disorder.

CSAM IS HERE TO HELP

If you or someone you love might benefit from acceptance and commitment therapy (ACT), cognitive behavioral therapy (CBT), or biofeedback for anxiety, depression, stress, or PTSD, or if you would like more information about our therapy services, please contact us at (858) 354-4077 or at csamsandiego@gmail.com.